Experts have described the new generation of drugs such as donanemab and lecanemab, which have been shown to slow down the progression of dementia, as a turning point in tackling the disease. But that’s only part of the story.
With the drugs most effective if they are used early, there is a growing need for new ways to diagnose dementia in the earliest stages, so patients can benefit fully from any treatments.
In the meantime, new ways to help those living with dementia to stay independent for as long as possible can also have a big impact.
Around 200,000 people in the UK develop dementia every year and a million people are currently living with the condition.
The Alzheimer’s Society says those with dementia occupy at least a quarter of hospital beds in England and are the most frequent users of adult social care services. Colin Capper, associate director of evidence and involvement at the Alzheimer’s Society, says: ‘If you’re living with dementia, then being in hospital is very challenging. It often causes a downward spiral in the condition.’
The Dorothy Community app allows people with dementia to find where they are going using a system similar to a satnav, that can be downloaded on to their smartphone or tablet
Here we look at a range of technologies — available now or in development — which could lead to earlier diagnoses, helping those with dementia live independently and stay out of hospital.
‘SATNAV’ TO MAP FAMILIAR PLACES
Sleep monitor aids diagnosis
A pad that monitors sleep quality could identify people at risk of dementia.
Data collected from the pad, which is placed under a mattress, is fed into a computer program that analyses ‘sleep signature’ — a measure of the quality of sleep.
This will be analysed using the ‘dementia sleep index’ — a marker of sleep quality that is sensitive to disturbances seen in dementia, which was created by Imperial College London researchers.
A new study called InSleep 46, taking place at University College London, will use the pad to identify participants whose sleep patterns suggest they are at risk of dementia; if it is proved accurate, it could then be deployed within the NHS.
The pad, which is around the size of a pillowcase folded in half, detects when someone gets in and out of bed, sleep interruptions, and heart and breathing rates.
Sleeping troubles are reported in about two-thirds of people with Alzheimer’s.
The Dorothy Community app allows people with dementia to find where they are going using a system similar to a satnav, that can be downloaded on to their smartphone or tablet.
The augmented reality app (which adds visual and other sensory information to enhance a real-life situation) maps everything in close detail. The user follows a ‘yellow brick road’ — the Wizard Of Oz reference is where the app’s name comes from — to where they choose. They select this location by pressing on icons such as bathroom and living room. The app, which received funding from the Longitude Prize on Dementia, has been tested in three care homes in Waltham Forest and Romford, in London, where people with dementia have used it via an iPad attached to a walking frame.
Dr Samir Shah, co-founder of the app and a consultant psychiatrist at North East London Foundation Trust, says it helped patients find their way to different rooms, which many of them could not do before.
‘We demonstrated that users were walking more and were less likely to develop urine infections because they were able to go to the bathroom often enough — a common cause of urine infections is not using the loo as much as you should do,’ he says.
‘If we can help people to be more active, this should keep them less frail and reduce the chance of falls. Usually, the less you do, the worse you get.’
The system uses GPS and object recognition to create the maps, then the creators add ‘places of interest’ such as bedrooms, medication counters, loos and where to get food and drink.
It can record useful information for a ‘companion app’ — used by a carer or relative — including how many times someone has visited the bathroom or if they have got up in the night. That means issues such as urine infections could be spotted and treated earlier.
Dr Shah adds: ‘Our ultimate aim is to make every public space dementia-friendly by using accessible technology.’
MONITOR TO REDUCE EVENING DISTRESS
An innovative project aims to lessen ‘sundowning’ in people with dementia — that’s agitation, restlessness, confusion and raised anxiety that starts in the late afternoon and continues into the night. It is thought to affect 20 to 30 per cent of dementia patients.
‘People experiencing sundowning may even have hallucinations and delusions,’ says Dr Rebekah Luff, a senior research analyst at the Social Care Institute for Excellence (SCIE) charity, which is collaborating on the project with the University of Stirling. ‘It usually happens farther into the stages of dementia, when it’s likely someone has had a diagnosis.’
A monitoring system developed by software company Anthropos Digital Care uses data collected from wireless sensors and monitors around the home, such as on doors, lights and kettles, to record their usage.
This data will be used to understand someone’s daily routines and spot any changes in behaviour that make sundowning more likely.
The SCIE team will use this data, together with information from people with dementia and their carers, to offer insights into how best to support someone experiencing sundowning — for example, by helping them maintain more of a routine, or altering the environment of rooms that are too dark or too cold — or picking up that the person has eaten early and so may be hungry in the evening.
Eye check to spot brain changes
Routine eye tests may be able to track the progression of dementia. A study by Queen’s University Belfast will look at scans of the retina, the light-sensitive tissue at the back of the eye, to detect changes which are thought to mirror those happening in the brain — the retina contains very similar cells to those in the brain.
‘In someone with Alzheimer’s there are yellow deposits of fatty proteins, known as drusen, below the retina which should not be there, in the same way that amyloid proteins build up and form plaques in the brain,’ says Dr Imre Lengyel, who is leading the research. ‘If the cell deposits grow quickly, it shows the disease is progressing.’
The research will study the eyes of people with Down’s syndrome, which is caused by a genetic abnormality that raises their risk of developing Alzheimer’s. Changes in annual eye scans and tear samples, which previous research has shown can contain inflammatory molecules associated with Alzheimer’s, will be used to check the eye is a good window to monitor disease progression, and will be compared with brain scans to see if they match up.
‘Our ultimate aim is to spot disease progression earlier,’ says Dr Lengyel. ‘Eventually we hope that looking for signs of Alzheimer’s and progression of the disease could be done at High Street opticians.’
‘The reasons why sundowning happens are not well understood but it’s likely that there are a range of factors,’ says Dr Luff.
‘There is some evidence that a disrupted body clock, or circadian rhythm, in someone with dementia is connected to sundowning — this can also impact daily routines — and changes in the eye and light also relate to this.’
The new system is planned to be tested on 15 people with moderate to late-stage dementia who live alone, by the end of the year.
HOLOGRAM GLASSES TO PROMPT RECALL
The CrossSense glasses might look like ordinary glasses but they use augmented reality to create holograms assigned to specific objects and people — the theory is that they help to improve recall in people with dementia.
‘The idea is that the user would learn to associate the additional stimuli provided by the glasses, such as a colour or specific music, with certain people or objects and in turn memorise things more effectively,’ explains Szczepan Orlowski, software and business developer at Animorph Cooperative, which makes the glasses.
‘For example, by associating a particular person, such as a husband or wife, with a certain colour or ‘aura’, the person with dementia would be trained to recognise this colour association over time and, in turn, recognise the person.’
The concept builds on research that found people with the neurological condition synesthesia — which leads to experiencing one sense through another, so hearing a word triggers seeing a colour, for example — have better memory in older age over the general population. One theory is that this is related to the strengthened connections in their brains.
The creators hope that using the glasses, which contain tiny cameras and microphones, will engage many areas of the brain, creating more connections, which will better stimulate the retrieval of information. The hope is that the user will not just have one way to recognise an object but several interconnected ones.
The device is personalised before use, for example by uploading images of someone’s relatives and frequently used objects, so it can recognise them when applying the hues and giving reminders.
The creator hopes to test the glasses on people with early to mid-stage dementia in the autumn. Their memory and recall abilities will then be evaluated to find out if the glasses have helped. The glasses currently cost around £2,700, but the price is expected to come down.
DOLL TO HELP REDUCE ANXIETY
Hug by Laugh (the name of the research team from Cardiff Metropolitan University that developed it) is a 45cm tall soft, sensory doll designed to mimic the sensation of being hugged by a loved one, for people with advanced dementia.
It has weighted limbs and a soft body that contains a simulated beating heart; and a music player that can be programmed to play a person’s favourite music.
Hug by Laugh (the name of the research team from Cardiff Metropolitan University that developed it) is a 45cm tall soft, sensory doll designed to mimic the sensation of being hugged by a loved one, for people with advanced dementia
You place the comforter’s upper arms around the shoulders and the doll will play music and return the cuddle.
‘HUG has been shown to be really effective in terms of improving wellbeing, especially in the later stages of dementia,’ says Simon Lord, head of innovation at the Alzheimer’s Society.
Research published earlier this year in the International Journal of Environmental Research and Public Health, involving 40 people with dementia, found using HUG could relieve anxiety and distress.
It also improved food and drink intake and made people better at taking medication and having medical procedures — because the hug alleviated the anxiety and distress that can make these things difficult for people with dementia.
CARD TO KEEP MONEY SAFE
Sibstar is a debit card that helps people living with dementia to manage their spending.
The card, which was developed by the daughter of a woman with dementia, is loaded with money by the person with dementia or their carer and can be linked to an app on a phone, which controls how and where the money can be used.
The person who has financial power of attorney for someone with dementia receives real-time alerts on their phone to keep track of any purchases — the notifications allow them to keep an eye on loved ones while maintaining the person with dementia’s independence. They can also act as a conversation starter to discuss the patient’s daily activities.
The same notifications can be set up to appear on the patient’s phone, which is thought to help jog their memory about what they have been doing that day.
The system is regulated by the Financial Conduct Authority and the card has a £4.99 set-up fee and a monthly subscription of £4.99.
‘People with dementia can make repeated purchases or buy things that don’t make sense to relatives,’ explains Colin Capper, from the Alzheimer’s Society, which helped to fund the initiative.
‘We also know older, more vulnerable people are more at risk from fraud, so this would help protect them. Sibstar has provided a solution that didn’t exist before.’
SPECTACLES THAT DETECT FALLS
Imagic smart glasses are designed to help people recognise familiar faces and make phone calls, as well as monitor their heart rate, body temperature and sleep duration — all key signs of wellbeing for older people living alone.
The hi-tech glasses are in development at Khalifa University in the United Arab Emirates and will be tested on people with different stages of dementia next year. They will contain a gyroscope (to measure orientation) and an accelerometer (to measure acceleration) which will assess movements and detect if someone falls or is likely to have a fall.
Any information that suggests someone is unwell or at risk of a fall can be shared with a carer.
The glasses, which will look like ordinary glasses with added sensors, batteries and connectors, will have a sensor which ‘sees’ a face and a module that would recognise it after running a comparison against stored familiar faces.
‘They will be like a small, wearable computer,’ says Dr Mohamed Seghier, a professor of biomedical engineering at Khalifa University.